Diagnostic value of trunk flexion-extension testing in old chronic low back pain patients

Eur Spine J. 2017 Feb;26(2):510-517. doi: 10.1007/s00586-016-4758-z. Epub 2016 Sep 6.


Purpose: Dynamic trunk flexion-extension testing has been proven to objectively diagnose low back pain in persons under the age of 60 years but older persons have difficulty complying with standardized movement velocity.

Methods: 190 patients and 71 matched healthy volunteers (18-90 years of age) performed modified testing by holding static positions at standing, half, and full trunk flexion.

Results: Lumbar extensor muscle activity in isometric positions was significantly higher in patients with higher activity in the oldest (60-90 years) and the middle-aged (40-59 years) but not in the youngest (18-39 years) subgroups compared to normal. There were no differences in gross trunk range of motion, half flexion relaxation ratio, proprioception, muscle activity differences between positions, and fear-avoidance behavior. The diagnostic accuracy as expressed by the area under the curve was fair (0.74).

Conclusions: Lumbar extensor muscle activity demonstrated moderate to good diagnostic value in old patients.

Keywords: Chronic back pain; Electromyography; Healthy volunteers; Kinematics; Proprioception.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Back Muscles / physiology*
  • Case-Control Studies
  • Chronic Pain / physiopathology*
  • Electromyography
  • Female
  • Humans
  • Low Back Pain / physiopathology*
  • Male
  • Middle Aged
  • Movement / physiology*
  • Muscle Strength / physiology
  • Young Adult